Participants’ experiences regarding the intervention
At the individual or intrapersonal level
Health and well-being. Reduction in lumbar spine pain and improvements in upper limb muscles, reactivity, and body coordination were the positive outcomes perceived by the participants.
One of the male participants (M4) expressed that SLVB helped reduce lumbar spine pain: “In the past three months, I often sat on the floor while playing SLVB. Eventually, I found that my lumbar spine and hip bones had become more flexible than before. I used to have lumbar spine pain. After playing SLVB, I found it less painful than before.”
He (M4) added that SLVB had strengthened his upper limbs although it was a bit tiresome: “It enhanced my body strength as well. When the receiving team wins every rally, it gains the right to serve and rotates before actually serving. The player who moves from the front-right position to the back-right position will serve. This rotation movement is even more tiresome than serving and smashing a ball. It strained my arms more than using the wheelchair did. Such lateral movements, through the use of different muscles, strengthened my arms over time. As such, I would say, SLVB is a pretty good exercise.”
Two female participants, (F3) and (F2), mentioned that SLVB enabled PA and improved reactivity. (F3) said, “It gave me a chance to do more exercise, which is good for my hands, legs, and joints. Unlike stretching exercises, SLVB entails the movement of my whole upper body. I found that my sensitivity is better. [Do you mean reactivity?] Yes, reactivity has become better.”
This wasechoed by (F2): “We are limited by our disabilities to do many things, such as running. SLVB gives us an opportunity to do aerobic exercise. It is also good for training our reactivity.”
Two male participants, (M6) and (M2), expressed that SLVB was good for bodily coordination: “We have to rotate and manage hand–eye coordination … Hand–eye coordination is important to receive” and “It demands reactivity and synchronization of the players…. As such, I think it is good for building our brain and body.”
In addition to physical health, potential improvements in mental health (positive mood and fewer worries) and quality of sleep were mentioned by a few participants.
A female participant (F5) said, “We often look at near objects and hence strain our eyes. When you play SLVB, you look at distant objects, which could be good for our eyesight. I think playing SLVB could help ease our mood, and it is good for our lumbar spine.” “Playing SLVB causes me to have a good mood. I become worry-free while focusing on the ball,” sheadded (F5).
“I feel more energetic. Besides, I slept well after playing SLVB. Yes. I think it has improved the quality of my sleep,” said another female participant (F3).
Enjoyment. Analysis of the semi-structured interviews demonstrated perceived enjoyment and happiness of the participants when playing SLVB.
“I would tell them that SLVB is something I never came across before. Playing SLVB is very joyful and a sort of exercise. I seldom exercised before I retired,” expressed a female participant (F2).
Another female participant (F4) said, “In general, I found SLVB fun-full to play with.”
One male participant (M3) expressed, “It is surely good. I saw that they were very happy to play SLVB. It was impactful, at least psychologically. The sports ground was full of happiness and laughter. They cheered when they served a good ball. They laughed when someone hit a ball beyond the lines. The atmosphere was joyous. (How about you?) I felt happy too.”
Another male participant (M6) exclaimed, “Once I started, oh, I love it!”
Some participants even went earlier to the sports ground for additional SLVB practice. One female participant (F11) reflected, “I think I really enjoy. Because I would arrive earlier, if the class started at 4, I could get some practice if I arrived at 3:30. I would practice serving as I knew I was not good at serving…. Yes, I was looking forward to it sometimes. Sometimes we would tell others to come earlier. The class started at four. We arrived 30 min earlier to practice so that we can play better.”
Novelty. Because SLVB was new to the participants, they were curious and eager to find out what it is, how it is played, and whether they could play this form of PA, which is for a healthy and strong body.
One female participant (F1) expressed, “Curiosity drove me to join the project. SLVB was new to me. The moment I heard of SLVB, I wondered if it can be played by wheelchair users like me. I was so curious to find out how it is played. Moving around the volleyball court, smashing a ball on my wheelchair, etc. are totally new to me. All these attract me to join the project.”
Another female participant (F2) reflected, “It was new to me. I never did it before.” She added, “I have done other exercises for at least three years. I never did SLVB. That is why I want to try.”
One of the male participants (M1) said, “I want to know more about SLVB as a sport…. I have known how to play a new kind of sport. If it is further developed into a regular sports item in the future, I would certainly play with my friend.”
Another male participant (M3) echoed, “I wanted to know what SLVB is about. I wanted to do more exercise for a healthy and strong body.”
Competence. Moreover, participants indicated that playing SLVB brought about a sense of competence derived not only from successful service, scoring points, and mastering techniques progressively but also from positive feedback from coaches.
One female participant (F1) said, “As a matter of fact, I am a fan of VB. Have you ever heard of Lang Ping? I like to watch her playing VB. I know the rules of the games. However, I have never played VB because of my disabilities and body weight. Thanks to the project, I am able to play SLVB.” She (F1) added, "What I enjoyed most was the joyous moment when we served a good ball and scored a point.”
She (F1) remarked further, "Within the team, we have a player who had a stroke. Playing SLVB is good for her even though she could just move one of her hands.”
Another female participant (F4) said, “I felt very happy when I served or received a ball well.” When asked if there was any psychological change after playing SLVB, she (F4) exclaimed, "I feel happier because I can make it. I can play!”
A sense of achievement was expressed by a male participant (M4) who received positive feedback from his coach: “What I enjoyed most was to listen to and apply what the coaches had taught me. For example, if I smashed a good ball, Y. W. Sir would praise me and said, ‘Well done; you have applied the skills I taught you.’ I got much sense of satisfaction from this positive feedback…. I am able to apply well the skills taught by the coaches. I can control well my position and direction while serving and receiving the ball.”
Autonomy. The participants positively expressed they attained body autonomy gain and sense of freedom from playing SLVB.
A female participant (F2) said, “Suitable. For instance, some players can do SLVB with just one hand. Despite our walking impairments, we are able to play SLVB in a sitting position. I do not know how to operate and control a wheelchair. I fear falling while playing SLVB in a wheelchair. Playing in a sitting position fits me very much.”
Sense of freedom was felt by a male participant (M6). He reflected, "After the caliper is removed, I can play it, rotate, and pick up the ball freely…… Now watching back the videos, I found myself so free in it…. I need neither wheelchair nor caliper, which is so delightful. I also feel like a dream as if I am an astronaut, no limitation and without caliper.”
In addition to body autonomy, self-regulation skills were evident by the participants routinely scheduling time for exercise. One female participant (F2) said, “Once I decide to do something, I am dedicated to doing it well. Just like playing SLVB, I didn’t miss any session unless necessary. That’s why I don’t often meet with my friends and family members, once every one to two months.”
Another male participant (M6) reflected, "My wife and I have attended more than 80% of the classes. It was quite fun. I was absent for four times. My wife reminded me that I had one quota left; otherwise I will fall into 80%. I traveled to Okinawa. Then I attended the classes every week and rejected all the dates with friends.”
At the relationships or interpersonal level
Socialization and communication. Other than physical and psychological well-being, the interviewees also described the social interaction effects of joining the SLVB intervention, namely mixing socially with others, discussion and exchange of information within teams, extension of social circles from one that mainly included wheelchair-bound friend to one that included volunteers, coaches, and the organizing team
“It …enlarges my social circle. It gives me a chance to interact with other people and volunteers and keep contact with my wheelchair friends. When I don’t do exercise, I usually stay at home.” Said a male participant (M2).
Another male participant (M1) mentioned, "The good things are…. and interacting with my friends. With my teammates, we discussed how to win a game strategically and adjust ourselves to play better.”
The socialization effect was echoed by a female participant (F2), "I felt quite happy to play and practice passing the ball in a small group…… I am happy to know a few new friends too.”
“Yes. It enlarges my circle of social interaction. It enables me to know more new friends.” Said another female participant (F3).
Through SLVB, another male participant (M6) extended his social circle beyond wheelchair-bound friends. “I met many coaches, like PY and R. It’s good to meet them. A new network formed which we can play together, like Yuk and Yin. Second, I can meet many people outside my zone, like people at the network of light volleyball, people who pick up the balls. The security guards are nice and help us open the door.”
Teamwork. Mutual inclusion, cooperation, team spirit, and combined action as a group resulted from the SLVB intervention.
A female participant (F2) said, “… Individual exercise differs from group exercise…. Group exercise demands mutual inclusion, cooperation, and interaction among the participants. For SLVB, you need at least ten people to make it playful.”
Another female participant (F1) remarked, "Absolutely, we played hard to win as a team. We cheered to each other whenever scoring a point. We were very happy as a team. It is awesome.”
A male participant (M3) expressed, "To me, SLVB is playful. It cultivates team spirit and demands the cooperation of each member….”
One male participant (M3) expressed that SLVB developed communication skills among the team members, "SLVB provides us with a chance to move around, stretch our muscles, enable communication within the team, learn how to interact with each other, and to follow instructions from the coaches. There are many advantages….”
Support from peers, friends, family members, coaches and volunteers as well as peer pressure were evident during the SLVB intervention.
Support from peers and friends was described by one of the female participants (F2): “Some of my classmates are very friendly. They are proactive to say “hello” to me and even invite me to play with them in a small group. They told me some tricks of playing SLVB, which had helped me do better.” She added, "I didn’t tell others except for my old friends. They said that wow, you were awesome!”.
Nevertheless, some participants found intangible pressure from her peers when servicing. “……I feared losing a point because it would affect the whole team. When it was my turn to serve a ball, everybody stared at me and told me to ‘add oil.’ This frightened me despite knowing the two-step approach Coach PY had taught me. I said to myself, ‘Don’t be afraid, don’t be afraid.’ However, it did not work out. The intangible pressure on me was so large that my hands were out of control.” One female participant (F1) reflected.
She (F1) elaborated, "Yes. I knew of their good intention to encourage me to serve the ball well. However, the more they yelled at me, the more nervous I become and the higher the chance of my serving the ball badly……”
Family support, which was crucial to engaging the participants in PA, was mentioned by many participants. One male participant (M2) said, “Most of them encouraged me to do so. My wife supported me too, even though she was more introverted than me.”
"Yes, they (family members) were very supportive. They said that it was good for me to go out and play more. They told me not to stay at home alone.” Echoed by a female participant (F2). "I felt that I have become more proactive than before (in knowing friends and social interactions).” She (F2) added
“I didn’t hear any objection. Both my family and daughter were supportive.” Said a female participant (F3). “They said, ‘It is good for you to do more exercise!’ (Verbal support?) Yes.”
Support and positive feedback from the coaches were evident by a male participant (M4): “What I enjoyed most was to listen to and applied what the coaches had taught me. For example, if I smashed a good ball, YW Sir would praise me and say, ‘Well done, you have applied the skills I taught you.’ I got much sense of satisfaction from this positive feedback. I really enjoyed the processes of learning, practicing, and applying the skills.”
Volunteer support was appreciated by a female participant (F4): “I am very thankful to those ball-boys and girls. (They were very co-operative, right?) Yes, absolutely. We played, and the balls were everywhere. They helped picking the balls for us quickly. They did a great job.”
At the perceived environment level
Comfort, privacy, and spaciousness. Comfort, privacy, spaciousness, and convenience of the venue affected the participants’ engagement in the intervention.
One male participant (M4) exclaimed, "Superb, superb! Unlike other playgrounds, there were no other players except us. I liked very much the privacy and comfort this playground gave me.”
Sufficient space was necessary to accommodate numerous wheelchairs and participants’ belongings. One wheelchair user (F1) commented, "The playground is big, and the indoor environment is ok.” One male participant M(6) commented on the sports ground: “It is convenient and comfortable inside the center. It is big enough to place our wheelchair and the air-conditioner is great. There is a restroom and drinking water on 1/F.”
Room temperature and accessibility to toilet are two of the environmental factors to engage in PA. One female participant (F4) said, “I am fine with that (the room temperature). It would be better if there were a toilet on the same floor. However, we could do little because this building is established. We have no alternatives. As for the temperature, we felt a bit cool upon arrival. It was about right after we played for a while and warmed up.” Another female participant (F6) commented on the room temperature: “It (the sports ground) is quite good, but sometimes the air-con is too strong.”
Accessibility concerns. As many participants were wheelchair users and have walking impairments, accessibility concerns were at the heart of the discussions.
Steep road leading to the sports ground. Accessibility to the sports ground is important to encourage participation in PA.One of the male participants (M3) said, “It is quite convenient to come here by train (Kowloon MTR station).…However, the steep roads leading to the sports ground are not convenient for wheelchair users.”
Another female participant who came by train (F10) echoed: No, the place is fine, but the way traveling there isn’t convenient at all. I take the train here and walking from the station to the venue is difficult. (Which station?) Kowloon Tong. It’s slope all the way. It’s easy on the way back home but not the way to the sports center. I will never come without an electric one.”
Parking space.Availability and proximity to disabled parking spaces are essential to engage in PA. One female (F4) participant said, “We drove to the venue. We got to wait for a parking slot downstairs.” She (F4) added, "They are (small). Sometimes we parked at the public car park downstairs which was always full. It was difficult to get space.”
However, for some participants with higher mobility, they can park at a normal though smaller parking space. One male participant (M2) said, “Given my mobility, I can manage to off-load or up-load my wheelchair even though the parking lot is a bit narrow. No big deal.” Another male participant (M3) commented, "There’s only one disabled people parking slot out there. Once occupied, others had to use HKBU’s car park, which some commented that it was too far away. I have always parked at HKBU’s car park. To me, it was quite close to the sports ground.”
Nevertheless, some participants were not discouraged by the accessibility issues. “I met many of the players on other occasions. Some are old friends, and we chat with each other sometimes. The changes are that many of them had become proactive to play SLVB although the venue was quite inconvenient to them, given the steep road, insufficient parking spaces, etc.” Commented by one male participant (M3).
Toilet.Availability of toilet facilities for wheelchair users is important. One female participant (F1) commented on the toilet facility: “Oh, it is quite troublesome going to the toilet downstairs….the toilet is not that accessible. Firstly, it is hard for us to pass through the twist and turn. Secondly, the door panel is too small and is not specially designed for wheelchair users. It is not spacious enough for me to move around. It was very difficult for me to close/open the door from inside….” She (F1) elaborated, "…I needed to call other team members to help close the door… going to the toilet is a big headache to me…!”
At the community/organizational level
Safety. Safety is a concern when playing sports, particularly for PWPD and people with relatively low fitness levels. When asked about the potential risks of playing SLVB, a male participant (M3) expressed, "Every sporting event has its own risk. SLVB players may strain their muscles; they may fall on the floor and get hurt if they don’t play it properly. At their ages, the chance of hurting themselves is higher. It would be troublesome if they hurt their hands.”
The disability conditions of the participants posed a potential risk of playing SLVB. “As I have walking impairment on one leg only, one side of my buttock is bigger than the other. As a result, I need to balance myself with one hand while sitting on the floor. This explained why I seldom use two hands and mostly one hand to receive the ball. Otherwise, I would lose my balance and fall backward. Besides, I could not bend my legs while sitting on the floor. That’s why my legs would cramp sometimes.” Said a female participant (F2). She (F2) added, "As our disabilities vary, some can sit with good balance while some can’t and need to support themselves with one hand on the floor. This makes it difficult for them to receive a ball with two hands. When they use both hands to receive a ball, they are vulnerable to fall.”
Nevertheless, the potential risk can be reduced by using proper techniques and protective gears, as mentioned by another male participant (M3):“The lumbar region of some is weak. They will fall straight down on the floor when they lose balance. As you said before, they should have been taught how to fall properly so as not to hurt themselves. For instance, how to use the elbow-supporters as buffers while falling.”
One female participant (F1) said, “SLVB is not that risky. The risk of falling could be higher if we played while standing up. While sitting on the floor, the risk of falling and hurting our hands is lower. The risk could be lowered by wearing elbow-supporters. The only potential risk is that our legs are powerless. Some team members suffered from abrasion while dragging or moving their legs on the floor.”
“The potential risk is that you could be hit by a ball. Sometimes, I fear being hit by a ball. Sometimes, I fear hurting my hands, which is no good for moving my wheelchair around. However, after playing for a few sessions, I know how to avoid the risk of being hurt. As the ball is light, it is no big deal even being hit by it.” Said a female participant (F4).
Dissemination of information. One female participant (F2) commented on the dissemination of information: “The enrolment process was smooth. However, I sometimes found that the dissemination of information was quite confusing…. For instance, there were occasions that we were not clearly informed of changes in the training schedules and venue. We didn’t know how to go to the new venue… It would be better if we could be informed as a group by a single party who has all our phone numbers.”
She (F2) added, "Some players may disagree with setting up a WhatsApp group because they don’t like to receive irrelevant personal messages. However, I think that the group should only be used by the responsible party to disseminate relevant information such as change in venue, training schedule, etc. One message will then be sent to all.”
Community facilities. The lack of wheelchair-accessible facilities in the community discouraged participation in PA (i.e., SLVB). One female participant (F1) expressed, "I rarely go out … for extra exercises … there are staircases and therefore not suitable to a wheelchair.” She (F1) added, "It takes time for the government to make good sportsground facilities…sportsgrounds are booked for playing basketball and badminton, leaving no room for us to play SLVB… Alternatively, I think the government should let us book community halls to play SLVB. Community halls are big. Even half of it is spacious enough for us to play.”
When asked if there was an alternative venue to play SLVB at HKFHY (the partner NGO), a male participant (M3) commented, "It is hard to do so. The ceiling of this room is too low; the activity room outside is full of stuff. HKFHY is not spacious enough.”
At the policy level
Resources allocation. Concerns about the sustainability of activity sessions were raised by participants, who wanted to see local government departments provide both financial and practical resources to support activity sessions .
One sporty male participant (M3) said, “Unlike wheelchair rugby and basketball, SLVB is played without a tailor-made wheelchair and in a sitting position. As such, I think it is ok and worthy of promoting SLVB as long as a sports ground is available.”
A female participant (F1) commented, "It takes time for the government to make good sportsground facilities, particularly for those located in old districts…Some sportsgrounds are so small that they could hardly be modified. Many sportsgrounds are booked for playing basketball and badminton, leaving no room for us to play SLVB. Alternatively, I think the government should let us book community halls to play SLVB. Community halls are big. Even half of it is spacious enough for us to play.”
Suitability and feasibility of our SLVB intervention elements
Suitability. SLVB is played in the sitting position and is relatively less vigorous and intensive; hence, it is perceived to be suitable for PWPD.
A female participant (F3) expressed, "As you know, most HKFHY members are disabled in their legs. Exercises requiring a lot of leg movements don’t suit us. Being played in a sitting position, SLVB is suitable for us.”
“I will tell them that SLVB is very suitable for disabled people to play. It is less vigorous than wheelchair basketball; you will not hurt your hands easily. SLVB could also enhance the flexibility of our arms and the tendons of our hip bones.” Reflected by another female participant (F4)
Another male participant (M6) said, “We…. should try using every part of our body. Light volleyball is the best one. I don’t play wheelchair basketball because the player will crash easily …. Crashing does not happen much in light volleyball, and we will not get hurt that often, so it is quite suitable for….wheelchair-bound people.”
However, due considerations have to be given to the disability conditions of the participants when mapping out an intervention program for PWPD.
“I am not good at coordinating my upper limbs. As such, I found it quite hard for me to play SLVB with my hands because of my disability. However, I am ok in general.” Said one of the male participants (M1).
Another male participant (M2) commented, "There’re different categories and levels of disabilities. At the very beginning, those with higher levels of disabilities could play it for fun and leisure. Gradually, they could progress to competition level as long as their body conditions can support.” “It fits for some with a normal upper body. It doesn’t fit for those with insensible lower limbs because they may hurt their legs easily while moving on the floor.”
(M2) commented further, "The participants have to judge themselves whether SLVB suits their physical condition or not. If it is an SLVB competition, there must be some pre-conditions to fulfill. If the aim is fun, it should be quite ok for people with lower ability. The soft and light volleyball reduces the probability of hurting themselves.”
Project contents and coaching. In general, the project contents were perceived to be adequate and progressive, and the caring approach adopted by the coaches was appropriate and made instructions easy to understand.
One male participant (M2) said, “It (the content) was adequate. It takes time for you to progress from not knowing to knowing how to play… The duration and progress of the project were good.” He (M2) added, "They (the coaches) were ok. They sat on the floor when coaching us. This was good because they could feel how we played in a sitting position.”
The comments of M2 were shared by two other male participants. (M3) echoed, "I think that the two coaches started with the basics and then gradually taught us more techniques of playing SLVB. (Step by step approach). It should be OK.” (M6) reflected, "There is theory, and it is taught in a structured way. It is easily understood.”
Duration of each session and scheduling. In general, participants preferred longer and flexible training sessions. A male participant (M2) said, “At least two to three hours per session. If the session is too short, you don’t have much time to play after warming up.” A female participant (F6) who wanted flexibility commented, "I think it is too short. It could be longer on Saturday night…. The class on Saturday should be 3 hours like the class now. We can play in groups. But not on Thursday, because I need to work.”
Number of participants and coaches. An appropriate coach to participant ratio is required. A female participant (F10) commented, "It’s a large number…. It should not cross 30; after 30, it is hard to satisfy everyone.” She (F10) added, "At the beginning, two coaches were enough….”
Modified rules. Unlike traditional volleyball, an SLVB player’s position is determined by the degree of contact of the buttocks with the floor or the playing court, which is also a parameter for assessing any fouls. However, a male participant (M3) suggested, "In our case, the six members of each team may have different levels/types of disabilities. Some may be able to raise their buttocks above the ground a bit, and some may not. You may consider skipping this rule. As such, it is needless for the referee to enforce this rule.” He (M3) added, "You should be flexible about that…. Option one: one or two designated members of each team are allowed to do that. Option two: only the most able-bodied member is allowed/disallowed to do that.”
Unlike SVB, where each player can serve multiple times until the team loses, each SLVB player can serve only once. When the receiving team wins every rally, it gains the right to serve and rotates (clockwise) before actually serving. The player who moves from the front-right position to the back-right position will serve. The participants’ views about this modified rule were mixed. Some said that it had better allow each player to serve multiple times until the team loses because this would give each player more chance to practice servicing. However, a female participant (F4) preferred the original rule, "I don’t think so. I prefer the original rule because the more we rotate, the more we move, and that is good for our body strength.”
The Social Ecological Model developed using the aforementioned findings is presented in Fig. 1.
[Insert Figure 1 about here]